J Med Virol . A systematic review and meta-analysis of children with Coronavirus Disease 2019 (COVID-19)

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J Med Virol


. 2020 Aug 6.
doi: 10.1002/jmv.26398. Online ahead of print.
A systematic review and meta-analysis of children with Coronavirus Disease 2019 (COVID-19)


Xiaojian Cui ¹ , Zhihu Zhao ² , Tongqiang Zhang ^{3 4} , Wei Guo ³ , Wenwei Guo ¹ , Jiafeng Zheng ³ , Jiayi Zhang ¹ , Cuicui Dong ¹ , Ren Na ¹ , Lisheng Zheng ¹ , Wenliang Li ¹ , Zihui Liu ¹ , Jia Ma ¹ , Jinhu Wang ⁵ , Sijia He ⁶ , Yongsheng Xu ³ , Ping Si ¹ , Yongming Shen ¹ , Chunquan Cai ^{7 8 9}



Affiliations

• PMID: 32761898
• DOI: 10.1002/jmv.26398

Abstract

Objective: To provide a comprehensive and systematic analysis of demographic characteristics, clinical symptoms, laboratory findings and imaging features of coronavirus disease 2019 (COVID-19) in pediatric patients.
Methods: A meta-analysis was carried out to identify studies on COVID-19 from December 25, 2019 to April 30, 2020.
Results: A total of 48 studies with 5829 pediatric patients were included. Children at all ages were at risk for COVID-19. The main illness classification ranged as: 20% (95% CI: 14 to 26%, I² =91.4%) asymptomatic, 33% (95% CI: 23 to 43%, I² =95.6%) mild and 51% (95% CI: 42 to 61%, I² =93.4%) moderate. The typical clinical manifestations were fever 51% (95% CI: 45 to 57%, I² =78.9%) and cough 41% (95% CI: 35 to 47%, I² =81.0%). The common laboratory findings were normal white blood cell 69% (95% CI: 64 to 75%, I² =58.5%), lymphopenia 16% (95% CI: 11 to 21%, I² =76.9%) and elevated creatine-kinase MB (CK-MB) 37% (95% CI: 25 to 48%, I² =59.0%). The frequent imaging features were normal images 41% (95% CI: 30 to 52%, I² =93.4%) and ground-glass opacity 36% (95% CI: 25 to 47%, I² =92.9%). Among children under 1-year old, critical cases account for 14% (95% CI: 13 to 34%, I² =37.3%) that should be of concern. In addition, vomiting occurred in 33% (95% CI: 18 to 67%, I² =0.0%) cases that may also need attention.
Conclusions: Pediatric patients with COVID-19 may experience milder illness with atypical clinical manifestations and rare lymphopenia. High incidence of critical illness and vomiting symptoms reward attention in children under 1-year old. This article is protected by copyright. All rights reserved.

Keywords: 2019-nCoV; COVID-19; Children; SARS-CoV-2; coronavirus; meta-analysis.